CREDIT/DEBIT CARD RECURRING GIFT
DONATION AUTHORIZATION
I hereby authorize my credit/debit card to make continuous payment to the MUSC Foundation, which is
to be processed on: THIS RESTRICTED ENDOWMENT FUND AGREEMENT
(“Agreement”) is made this ___ day of _________, 20__, by and
_________1st or _________15th
between __________________________, whose current address
is ______________________________ (the “Donor”), and the
-OR- Medical University of South Carolina Foundation, a non-profit
South Carolina corporation (the the 1st and 15 to
__________Split payment evenly and process Biweekly on“Foundation”), th create a
restricted endowment fund of the Foundation. All persons and
Charge Amount: $____________________________
organizations making contributions to this fund shall be bound by
the terms of this Agreement.
Start Date:______________ End Date:_____________ , or until I notify otherwise.
(Month & Year) (Month & Year)
1. Name of the Fund. The name of the Fund created hereby
is the ____________________________ Fund (the “Fund”). Any
Frequency of Credit/Debit Charge (circle one): Biweekly Monthly Quarterly Annually
recipient of benefits form the Fund shall be advised that such
benefits are from the Fund.
Please see credit/debit card information below.
Account Number. AmericanExpress
Credit/Debit Card Type (Circle One): 2. VISA MasterCard The account number of Discover is the Fund
_____ _____________.
Account Number: _______________ - _______________ - ________________ - _______________
3. Contributions. Upon signing this Agreement, the Donor
Expiration Date: ___________________ transferredCSC# (back of card): _______________ cash or
has and delivered to the Foundation the
property listed on Exhibit A, which is attached hereto and made a
Name as it appears on card: __________________________________________
part of this Agreement. All funds delivered by the Donor to the
Foundation and
Signature: ____________________________________designated as contributions to the Fund shall
Date: ____________
become the assets comprising the Fund, and shall be subject to the
terms of this Agreement. Others may make contributions to the
Donor’s Name: ________________________________________________ RE ID#:________________
Fund, but all such contributions are and shall be held for the
Address: _____________________________________________________________
purposes and uses, and on the terms and conditions, set forth in
this Agreement.
City: ________________________________ State: ______ Zip Code: ____________
4. Purpose.
Phone Number: (H) _______________ (B) ________________ (C)_______________
Email: __________________________________________________ the Fund is to create a permanent
(a) The purpose of
endowment, the income from which may be used for
MUSC Foundation Fund: __________________________________________
___________________________________________________.
Purpose: ________________________________________________________
(b) If at any time the President of The Medical
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University of South Carolina (“MUSC”) and the Chairman of the
In Memory of: ______________________________In Honor of: __________________________________
MUSC Department of_____________ certify to the Board of
Acknowledgement is to be sent to: Directors of the Foundation that the purpose stated above has
Name: _________________________________________________ become unnecessary, incapable of fulfillment, or inconsistent
with the needs of the Medical University of South Carolina
and/or City: ____________________________
Address: _____________________________,the purposes and functions of the Foundation, the
Foundation shall consult with the Donor, if then surviving and
State: ______ Zip Code: _______ Acknowledgee’s relationship to the deceased/honoree: _______________________
reasonably available, to determine some other purpose or purposes
for (3) tax-exempt If the Donor is not then surviving or the fullest extent of
The Medical University of South Carolina Foundation is a 501(c) the Fund. charitable organization. Your contribution is tax deductible tois otherwise the law.
unavailable, the Fund may be used for such other purpose or
18 Bee Street MSC 450 Charleston SC 29425-4500 Tel (843) 792-2678 Fax (843) 792-8531 www.musc.edu/foundation
Gifts as may be designated by the Board of Directors of the
purposes can also be made online at www.musc.edu/giving
Foundation. 10/08/2013
5. Endowment Spending Rate. The Foundation's
objective is to preserve and enhance in real dollar terms the